From the July 2018 issue of HealthCare Business News magazine


“[Breast MR] is out best screening test available, and we think it needs to be extended to more patient populations so that more people can benefit from it," Morris said.

A personalized approach
While there have been some differing directives concerning what age women should commence mammography screenings, the existing body of evidence shows that mammography is an excellent first line of defense against breast cancer. According to the ACR, since mammography became widespread in the 1980s, the death rate from the disease among women has dropped 39 percent.
“Microcalcifications show up on mammography that doesn't show up on breast MR, and very often microcalcifications are the first sign of breast cancer," said Brown. "The other thing is that specialized radiologists are required to interpret breast MR. So going to a facility that has the equipment and the radiologists specially trained … is important.”

At Yale University School of medicine, the program has evolved into a regional high-risk breast cancer referral center using digital breast tomosynthesis (or 3D mammography), but they still rely on MR screening for high-risk patients, according to Dr. Madhavi Raghu, assistant professor of radiology and biomedical imaging.

“The patients that are getting MR in our practice are patients [whose] malignancies are difficult to see on tomosynthesis or … they have extremely dense breasts – especially younger patients,” she said. “MR is especially useful for patients who have a strong family history or carry mutations … or younger patients. But for us, we're able to find some of these lesions with tomo before the patient gets [referred] to MR.”

Until recently, MR breast cancer screening with contrast (gadolinium) was reserved for “super high-risk” patients, according to Morris. But with the rapid advancement in technology – including risk factor tests women can buy on their own – individual breast cancer assessment is becoming more personalized.

“As we have entered in this new era of precision medicine and personalized screening, we realize that not everyone's risk is the same," Morris said. "There is a whole stratification of risk that we’re missing. There are women at intermediate risk of 12 to 20 percent, that’s what the new [ACR and SBI] guidelines are recognizing.”

MR secondary breast screening ‘lights up’ cancer for patients
In addition to finding breast cancers sooner, breast MR can also expose the aggressive forms of the disease before the cancer metastasizes. In a 2017 study published in Radiology, a German research team made the case that MR breast screening is also valuable for screening women at average risk of the disease, echoing Morris’ assertion that the procedure should not be limited to high-risk patients.

July 2018 Magazine

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